JOURNAL

SPEAKING BOOKS

Literacy is a luxury that many of us take for granted. We depend on written communication for information, guidance, and access to heath care information That is why SADAG created SPEAKING BOOKS and revolutionized the way information is delivered to low literacy communities. It's exactly what it sounds like.a book that talks to the reader in his or her local language, delivering critical information in an interactive, and educational way.

The customizable 16-page book, accompanied by local celebrity audio recordings, ensures that vital health and social messages can be seen, heard, read and understood..

We started with books on Teen Suicide prevention , HIV, AIDS and Depression, Understanding Mental Health and have developed over 30 titles, such as TB, Malaria, Polio, Vaccines for over 30 countries.

All of us have some things we worry about more than others, and many people have certain rituals or routines that they follow daily. New parents may fret constantly about their baby. If the child becomes sick, all other activities may be put aside to care for that infant. People with detailed routines may eat lunch at precisely noon and go to bed at exactly the same time each day. While these behaviour patterns may not be suitable for everyone, they meet the needs of the individuals involved.

But some people’s worries and rituals get out of control. Their lives become dominated by thoughts and behaviour they know make no sense, but are powerless to stop. When such behavior begins to interfere with a person’s normal activities, he or she is suffering from a serious - but treatable - medical disorder called Obsessive-Compulsive Disorder, or OCD.

Obsessive-Compulsive Disorder is a type of anxiety disorder that can strike at any age but often begins in early adult life. The illness afflicts 2-3 % of the population in all economic brackets and all races and religions, during any given year. It can overwhelm their lives, making them unable to work, socialize, or enjoy family life.

Individuals with OCD tend to hide their problem rather than seek help. They often are extremely successful in hiding their behaviour and may delay therapy for many years. Unfortunately, this delay reduces the chances of successful treatment because the obsessive-compulsive habits become more deeply ingrained with time.However, current theories indicate that OCD is a biological disorder that can be successfully treated. This brochure was designed to help you learn about OCD, and how to cope with your loved one’s OCD and help manage the disorder.

Most people occasionally get a thought stuck in their head or check a few times to see if they turned off a light or the stove. However, people with OCD are so preoccupied with a thought, or so compelled to check and recheck, that this interferes with their normal routine of the day. Obsessions are unwanted, recurrent and unpleasant thoughts that cause anxiety. Compulsions are repetitive, ritualistic behaviors that the person feels driven to perform to decrease anxiety. The obsessive thoughts or acts of performing compulsive rituals often takes up many hours of each day.Although individuals with OCD may know that their thoughts and behaviours make no sense, they are compelled to continue them.Many individuals with OCD often hide their symptoms from family and friends and are embarrassed to seek help, often because others will think them “crazy”. You may suspect that someone you care about has OCD, but may not know for sure because you haven’t seen the behaviours listed or heard them discuss their obsessive thoughts.

According to the Obsessive Compulsive Foundation, there are other clues to OCD that you can look for, including:• large blocks of unexplained time• persistent absence from work or school• repetitive behavior• constant questioning and need for reassurance• simple tasks consistently taking longer than usual• perpetual lateness• increased concern over little things and details• extreme emotional reactions to small things• inability to sleep properly• staying up late to get things done• change in eating habits• avoidance of certain things or situations• daily life becomes a struggle

It’s important to remember that these changes - which may seem like personality changes - are part of the illness and not part of an individual’s personality.

WHAT ARE COMPULSIONS AND OBSESSONS?

In order to understand OCD it is first necessary to know something about the nature of obsessions and compulsions.

Most people with this disorder understand their obsessions are unrealistic or excessive, but feel unable to control them.

Fear of Causing Harm to Another Putting poison in food, spreading illness, smothering a child, pushing a stranger in front of a car, running over a pedestrian

Fear of making a mistake

Setting fire to a house, flooding the house, losing something valuable, bankrupting the company

Fear of Behaving in a Socially Unacceptable Manner

Swearing, making sexual advances, saying the wrong thing

Because the anxiety and other feelings triggered by obsessions can be so distressing, people with OCD develop strategies to try to feel better. These strategies, called compulsions or rituals, are attempts to relieve the distress caused by obsessions. For example: people afraid of dirt may wash their hands over and over again. An individual afraid of causing harm to other people may spend hours rechecking the stove to see if it is still turned off. Usually, compulsions are performed in a stereotyped, repetitive fashion which can be mental rather than physical. Typically, the relief is only temporary, and the individual with OCD realizes the ritual or “compulsion” makes no sense but does it anyhow.

COMMON COMPULSIVE, RITUALISTIC BEHAVIORS

Checking Repeatedly checking to see if light switches, appliances and taps are off, if doors are locked, numbers are correctCounting / Repeating Counting to a certain number or counting objects over and over; repeatedly performing a behaviour before being able to move onCollecting / Hoarding Collecting old objects, mail or trash to the point of filling up one’s homeCleaning / Washing Hand washing, showering or cleaning oneself repeatedlyArranging / Organising Arranging items in perfect symmetry or in a certain order (for example, cans or books on shelves)

WHO GETS OCD

Until recently, OCD was regarded as a rare condition, but recent studies indicate that up to 3 percent of the population have experienced an obsessive-compulsive disorder at some point in their lives. Symptoms tend to begin during the teen years or early adulthood. About one-third of people with OCD show the first signs of a problem in childhood.Men and women are equally likely to suffer from OCD, although men tend to show symptoms at an earlier age. Cleaning compulsions are more common in women, while men are more likely to be checkers.

WHAT CAUSES OCD?

No one knows for certain what causes OCD. What we do know, is that some theories are outdated and untrue. For example, at one time it was speculated that OCD resulted from family attitudes or childhood experiences, including harsh discipline by demanding parents. Today evidence suggests biological factors contribute to the development of OCD. Some recent studies have found high rates of OCD in people with Tourette’s syndrome, a disorder marked by muscle tics and uncontrollable blurting out of sounds. There is some tendency for OCD to run in families. Some casues of OCD can begin in childhood after a Streptococcal throat infection or Rheumatic fever.

Obsessive-compulsive illness often has an association with depression.This is secondary to the distress and sense of lack of control occupied by the OCD Some patients suffer from only obsessive-compulsive disorder, while others suffer from both OCD and depression. And, many people suffering from depression also suffer from obsessive-compulsive behavior. Scientists do not yet know whether the two illnesses occur at the same time or whether one is a complication of the other. The link between OCD and depression is strengthened by the similarity in laboratory tests conducted on patients suffering from these illnesses.Obsessive-compulsive disorder sufferers also have many emotional symptoms associated with depression including guilt, indecisiveness, low self-esteem, anxiety and exhaustion. The many obsessive-compulsive patients who also suffer from depression will often seek treatment only when their depression reaches an extreme stage.

TRICHOTILLOMANIA OR COMPILSIVE HAIR PULLING

WHAT IS TRICHOTILLOMANIA

Currently, Trichotillomania is classified in psychiatry as a disorder of impulsive control, along the lines of pyromania, kleptomania and pathologic gambling.

WHAT ARE THE SYMPTOMS

There is virtually always some anxiety associated with the illness. Many describe the hair pulling as relieving this anxiety. On the other hand , compulsions such as the fear of losing control and becoming completely bald can cause and extreme heightening in their anxiety. Some people may have the habit of playing with the hair in some manner after pulling it out, They may touch the root in the lips or pull it through the lips of hands. A few will eat the hair (this is called trichophagy), that in rare cases has resulted in the need for surgical removal of the indigestible hairball from the stomach.Some describe pulling out hair that feel “wrong” and will continue to pull their hair until they have pulled the “right” hair. Others select a “favorite” area of the scalp (or elsewhere) to pull form which may change in location over the years. Any area of the hair growth such as the beard, chest hair leg hair or pubic hair may be involved.The hair pulling is generally not painful. Patients may be engaged in hair pulling from minutes to hours a day and often is done when they are left alone. The preponderance of people requesting help for this disorder are woman, although there is no proof that it is common in woman.

HOW AND WHEN DOES IT GET STARTED

The age that people first start compulsive hair pulling is frequently around 12 or 13 years old, although it is not uncommon to see it starting at a younger age or much older. Frequently associated with the first onset is a stressful event such as abuse, death, and illness of a parent. Whether this is a cause or coincidence is unknown and certainly the majority do not recall any precipitating stresses.

WHAT IS THE CAUSE

There is no one, single cause of trichotillomania. There may be a combination of factors such as a generic predisposition and aggravating stresses or circumstances, as with so many other illnesses.

WHAT TREATMENTS ARE AVAILBALE

Because we don’t have a way of determining the cause in most cases the treatments is generally “empirical”, meaning that different treatments may need to the trial before finding the one that works.The most common treatment for trichotillomania reported in the past has been the behavioural treatment, however medications are receiving the most research attention at the present. Medications, especially the selective serotonin re-uptake inhibitors (SSRI’s) appear to have helped with resisting the urge to pull hair. In most cases where there is a good response to the medication, the urge eventually goes away entirely (perhaps with occasional, mild relapses). The medication is not considered a cure, however, as with most chronic illnesses, will probably need to be taken life-long. The advantages of medications include ease of treatment, reduction of depression or obsessive compulsive symptoms in many patients, and the compatibility with the idea that the illness is a medical one. Viewing trichotillomania as a medical illness rather than an uncontrolled habit may be beneficial in the reducing self-derogatory feelings. The disadvantages include possible side effects and theoretical risks on long term medication treatment.

CAN OCD BE TREATED

There have been great strides in the treatment of OCD in recent years, and many people with the disorder report that their symptoms have been brought under control or eliminated. Even without treatment, OCD symptoms vary with intensity and may vanish for a time. But the symptoms can return, and treatment almost always is advisable. Individuals who get professional help are often able to resist their compulsions and are able to regain control of their lives.There are different treatment options available for OCD, including medication, behaviour therapy or a combination of both. Research has shown that both medication and behaviour therapy are very effective in treating OCD. The optimal combination requires both medication and behaviour therapy.A family doctor can help by prescribing medication or providing a referral to a qualified specialist whom has experience-treating OCD. A psychiatrist will be able to prescribe an appropriate medication and also provide behavior therapy. Some psychologists are trained in behavior therapy, but are not licensed to prescribe medication.

WHAT ARE THE TREATMENTS FOR OCD

Behaviour TherapyMedication and behaviour therapy often compliment each other. While medication alters the brain’s serotonin level, behavior therapy helps the patient learn to resist the compulsions and obsessions. Research has shown that over a period of time, behavior therapy can also change brain chemistry.Behaviour therapy teaches an individual how to confront his or her fears and reduce anxiety without performing the rituals. Gradually, the person exposes himself or herself to situations that cause anxiety, but refrains from performing the rituals that relieve the anxiety. For example, a person might be exposed to the floor, garbage or another object that is considered contaminated. This will cause anxiety for the individual, but he or she will not relieve these feelings by washing, cleaning or performing rituals. Over time, the individual realizes that the feared consequences will not occur and the anxiety decreases. This is a process called habituation. For example, therapy for a compulsive cleaner who previously could not handle money without washing her hands might involve counting money without washing her hands. This technique works well for patients whose compulsions focus on situations that can be recreated easily.When compulsive rituals are based……. feared catastrophic events that can’t be recreated, therapy for these patients must rely on imaginal exposure.

Throughout behavior therapy, the patient follows guidelines or a “contract” on which the psychiatrist/psychologist and patient agree. For example, the contract may outline whether a patient can perform any part of his or her ritualistic behavior and, if so, for how long and under what circumstances. A compulsive washer may agree to shower for only 10 minutes a day. Compulsive checkers may be permitted to check door locks, gas stoves or knives only once a day.Careful studies show that behavior therapy can effectively reduce compulsive behavior and significantly lessen the chances for relapse. But behavior therapy depends on the patient’s ability to keep his or her part of the treatment contract. Throughout therapy the therapist coaches patients to fight their compulsions. Often, family members also coach and support their loved ones to stick to their therapy. In some cases family therapy can be a valuable supplement to behavior therapy and medication. Family counseling sessions can help both the individual with OCD and his/her family by increasing understanding and establishing shared goals and expectations.

Other Treatments

Forms of psychotherapy other than behaviour therapy can sometimes be helpful additional treatments for OCD. Support groups - meetings with others who have the same problem - can also be useful. Family involvement in the process is often valuable, and sometimes essential. Unwillingly, family members may be contributing to the illness by accepting the ritualistic behaviours. This antidotes the illness and there is less motivation for the patient to refrain from compulsions

MEDICATION

Medication often plays a prominent role in the treatment of OCD and is particularly helpful for patients who also have depression or who are bothered by obsessions but do not perform compulsive rituals that can be modified by behavior therapy.

A class of drugs called Selective Serotonin Re-uptake Inhibitors (SSRIs) has been helpful in reducing OCD symptoms. Changes in serotonin levels are believed to be associated with OCD. These drugs traet the obsessions and compulsions , reduce anxiety and treat depression.Medications approved for the treatments of OCD in South Africa are Anafranil (clomipramine); Aropax (paroxetine); Cipramil (citalopram);.Luvox (fluvoxamine); Prozac (fluvoxetine) and Zoloft (sertraline). Anafranil belongs to the group of tricyclic antidepressants and the rest are Selective Serotonin Re-uptake Inhibitors.

SSRI medications may be used alone or in combination with other drugs, depending on the individual case. Scored tablets as well as liquid are now available, making use for children easier. Some tablets come in two tablet strengths, both of which can be broken. For a few individuals, being on medication for a period of time is all that is necessary. For the majority, however, medication may need to be combined with behavior therapy.

People respond to medication differently, and your physician will be able to prescribe the one best suited to you. These medications need usually to be given at high doses rather than one usually uses for example in depression. It is important to know that the full effect is delayed and may take up to three months to take effect. It is important to stress that a combination of madication and behaviour Therapyis probably betterthan either treatment alone.

As with all medications, you should talk with your doctor about side effects and possible interactions with other drugs being taken. It is important to work closely with your doctor to monitor your response to the medication. It is important to note that, the maximum improvement of symptoms may not occur for several weeks or months.The dosages necessary for the effective treatment of OCD are higher than the usual dosage for depression. At least three months on an adequate dose of an SSRI is needed before a response is seen.

There are several things you can do to help the individual with OCD learn about the disorder and the treatments that are available, such as:• If you live with an individual with OCD, bring information into the house, such as booklets, videos, audio tapes, etc. Leave it where your loved one will see it, sothat he or she will be able to read or listen to it on their own.• If your friend or relative tries to involve you in their OCD, tell them that you donot wish to participate in the behaviors he or she needs to do. You will help them to resist the compulsions, you will not assist or do them. Explain that you aretrying to understand what he or she is going through, but that if you give in to hisor her demands, it will only make the situation worse.• Encourage the individual by telling him or her that they are not alone and thattreatments for OCD are available. Assure them that with treatment, most peopleexperience a significant decrease in symptoms.• Suggest that the person with OCD speak to a mental health professional, ordoctor.• If the individual with OCD still refuses to acknowledge that there is anythingwrong, don’t be afraid to take definitive action. Gently explain to him or her thatyou will not be involved in the OCD.• Also be sure to explain to them that your offer to help find a doctor or therapist still stands. This detachment will not be easy for you, but it is important to holdthe line and not give in.• Once your relative or friend has acknowledged their OCD, has begun to get helpand can speak openly about the disorder, consider that the recovery process has begun. You may wish to discuss with your loved one and their therapist your role in this process.You can play a very important role in OCD’s treatment and in helping your loved one to learn to manage the disorder.

Everyone, especially children, need someone at home to provide coaching and support. Each family member and friend can help the individual with OCD by reinforcing good behaviors and helping him or her resist inappropriate ones. Working with your family’s therapist and the individual with OCD, you should be able to establish specific guidelines to follow at home.

FOUR PRINCIPLES TO REMEMBER WHEN LIVING WITH SOMEONE WITH OCD:

1 Be supportive. Discuss OCD with your loved one and listen to his or her concerns.2. Recognize gains made during treatment and be flexible during stressful times.3. Be consistent. Set rules for behavior and stick to them. Keep your family routinenormal and keep communication clear and simple.4. Be positive. Remember that OCD is no one’s fault. Try not to react to OCD critically or as if it is part of your family member’s personality. The individual with OCD already may have a low self image. The more critical you are, the worse they will feel.

COULD IT BE OCD

QUESTIONNAIRE

OCD responds well to treatment, which means people who hide their illness are suffering needlessly. If you suspect OCD, the first step toward regaining control of your life is to seek help.

Answer Yes or No to the following questions, then bring this page with you and show it to the doctor at your first visit.

Do you have unwanted ideas, images or impulses that seem silly, nasty or horrible?

Do you worry excessively about dirt, germs or chemicals?

Are you constantly worried that something bad will happen because you forgot something important, like locking the door or turning off appliances?

Are you afraid that you will act or speak aggressively when you don’t really want to?

Are you always afraid you will lose something of importance?

Are there things that you feel you must do excessively or thoughts you must think repetitively, in order to feel comfortable?

Do you wash yourself or things around you excessively?

Do you have to check things over and over again or repeat them many times to be sure they are done properly?

Do you avoid situations or people you worry about hurting by aggressive words or deeds?

Do you keep useless things because you feel that you can’t throw them away?

Having more than one illness at the same time can make it difficult to diagnose and treat the different conditions. Illnesses that sometimes complicate anxiety disorders include depression and substance abuse.So, please take a minute to answer the following questions, as well.

Please answer Yes or No?

Have you experienced changes in your sleeping or eating habits?

More days than not, do you feel:-Sad or depressed?Disinterested in life?Worthless or guilty?

During the last year, has the use of alcohol or drugs:-Resulted in your failure to fulfill responsibilities with work, school, or family?

Placed you in a dangerous situation, such as driving a car under the influence?

Gotten you arrested?

Continued despite causing problems for you and/or your loved ones?

PLEASE SEEK TREATMENT IF YOU ARE AT ALL CONCERNED.

EMERGENCY LINES

Dr Reddy's Help Line0800 21 22 23

Cipla 24hr Mental Health Helpline0800 456 789

Pharmadynamics Police &Trauma Line0800 20 50 26

Adcock Ingram Depression and Anxiety Helpline0800 70 80 90

ADHD Helpline0800 55 44 33

Department of Social Development Substance Abuse Line 24hr helpline0800 12 13 14SMS 32312